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Association of the Metabolic Syndrome with Severe Periodontitis in a Large U.S. Population-Based Survey

Periodontology Unit, UCL Eastman Dental Institute (F.D., N.D.), London WC1X 8LD, United Kingdom; Center for Clinical Pharmacology (A.D.H.), University College London, London WC1E 6JF, United Kingdom; Department of Epidemiology and Public Health (W.S., G.T.), University College London, London WC1E 6BT, United Kingdom; Department of Primary Care and Social Medicine (G.N.), Imperial College London, London SW7 2AZ, United Kingdom; and Vascular Physiology Unit (J.D.), Institute of Child Health and Great Ormond Street Hospital for Sick Children, London WC1N 1LE, United Kingdom

Address all correspondence and requests for reprints to: Dr. Francesco D'Aiuto, Periodontology Unit, UCL Eastman Dental Institute and Hospital, 256 Gray’s Inn Road, London WC1X 8LD, United Kingdom. E-mail: f.daiuto{at}eastman.ucl.ac.uk.

Context: Metabolic syndrome and periodontitis both have an increasing prevalence worldwide; however, limited information is available on their association.

Objective: The objective of the study was to assess the association between periodontitis and the metabolic syndrome in a cross-sectional survey of a nationally representative sample of the noninstitutionalized civilians in the United States.

Design, Setting, and Participants: Data analysis from the Third National Health and Nutrition Examination Survey on 13,994 men and women aged 17 yr or older who received periodontal examination were studied.

Main Outcome Measures: Association of diagnosis and extent of periodontitis (gingival bleeding, probing pocket depths) with the metabolic syndrome and its individual component conditions (central obesity, hypertriglyceridemia, low high-density lipoprotein-cholesterol, hypertension, and insulin resistance) were measured. Adjustment for age, sex, years of education, poverty to income ratio, ethnicity, general conditions, and smoking were considered.

Results: The prevalence of the metabolic syndrome was 18% [95% confidence interval (CI) 16–19], 34% (95% CI 29–38), and 37% (95% CI 28–48) among individuals with no-mild, moderate, and severe periodontitis, respectively. After adjusting for confounders, participants aged older than 45 yr suffering from severe periodontitis were 2.31 times (95% CI 1.13–4.73) more likely to have the metabolic syndrome than unaffected individuals. Diagnosis of metabolic syndrome increased by 1.12 times (95% CI 1.07–1.18) per 10% increase in gingival bleeding and 1.13 times (95% CI 1.03–1.24) per 10% increase in the proportion of periodontal pockets.

Conclusions: Severe periodontitis is associated with metabolic syndrome in middle-aged individuals. Further studies are required to test whether improvements in oral health lead to reductions in cardiometabolic traits and the risk of metabolic syndrome or vice versa.